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k <br />AM BUTION #04493 <br />t ° <br />a Gen oriVatrte . } t G9ne[t;<ti <br />g Location: 77, <br />, <br />� r <br />'Address: <br />. <br />j <br />Z41S ' <br />.'STRMT <br />y0 <br />^ <br />e.' Phone' No <br />- <br />If owner of th e genen3ting facility differs #rom the genSrator;.provide: •. :' `` <br />- <br />Owne�s Name 'R01]�OCTS QQ YSam <br />as I(e) <br />g. h ...Owner's. <br />hone No.. <br />'. <br />-� <br />i. BFI WASTE OC3DE , oZ <br />9� <br />Containers <br />DM - METAL DRUM <br />pP -PLASTIC DRUM <br />r <br />B -BAG <br />j. Description of Waste k: Quant' <br />units No. TYPE <br />BA - 6 MIL PLASTIC BAG <br />0 0 <br />O% Yn 0 Z <br />T TRUCK or WRAP <br />►<: !� <br />D -OTHER <br />GENERATOR'S CERTIFICATION: I hereby certify that the above named material Is not a hazwdot <br />s waste as defined by 40 CFR Part 261 or <br />UNITS <br />any applicable=state taw,'.has`been-property described, -classified and packaged, and is in pro <br />r condition for transportation -according to <br />P -POUNDS ' <br />' applicable regulations; AND, If the waste'is a breabnentrestdue of a prerAously'reahfeted haz <br />irdaus waste subject to the Land Disposal <br />Y - YARDS <br />Restrictions, l certify: and warrant that the:waste has bem bealed In accarCance a naqu <br />ants of 40 CFR Part 268 and 's no longer a <br />M' -CUBIC METERS <br />hazardous waste as defined by -40 CFR Part 261. 5. r f' <br />. PRODUM t�pANY <br />Y3 - CUBIC YARDS <br />s <br />> ► D <br />a6 r 5 <br />O - OTHER .. <br />Generator AuCiarized Ag6ttt Name <br />Shipment Date <br />0000v <br />' TRANSPORTER II •' <br />h. Nam <br />i. � Add <br />Driver Name/Title: <br />MHrfrYPE <br />1 k.. Phone No.: E. Truck No:: <br />M. Vehicle <br />d. Phone No.:e. Truck N <br />f. 'Vehicle ,Llm' cense No:/State: <br />-Acktoedoemeof eke61 of Materials. <br />n. <br />BFI -- VASCO RO ::SANITARY LANDFILL <br />a. Site Name' -- ..., C. <br />4001 H. VASCO ROAD <br />b.. Physical Address: d. <br />LIVERMORE, CA 94554 <br />e. Discrepancy Indication Space: <br />I hereby certify that the above named material has been accepted and to the best of <br />f. <br />Name of Authorized Agerrt <br />lJeertse No./Stale:------ <br />(925) 44 <br />Vedgement of Receipt of Materials. <br />No.: <br />Address <br />7-0491 <br />4001 t3. VASCO ROAD <br />LIVERMORE, ^A 94554 <br />knowledge the foregoing is true and accurate. <br />i J'OB# 1007-112 <br />::'O# 09-30313 <br />Reoeipt Date <br />a. Shippers%* Name: b. Shl pers's* Phone No.: <br />C.' 61iippers's* Address: <br />d. Shippers's Special Handling Instructions and additional information: <br />CERTIFICATION: I hereby declare that the contents of this consignment are fully and accura ely described above by proper shipping name and are classified, packaged, <br />marked, and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. <br />